Home Heath LPN doubles as Para in school

Crystal-Wings, LVN · Oct 16

Did you report to your agency? Also, why are you charting such long detailed notes if there is no change in condition? When I did in home care it was every 2 hours and it was on a tablet and it was mostly check boxes. If there was a change in condition, that's when we wrote more detailed notes.

Littlenurse01 · Oct 17

He is trach/vent plus wears a passey. I have to chart every hour or more on his respiratory status, more if it changes and his lung sounds. And because we are in school I chart when he gets his therapy and what was done. I also chart when I give him his feeding, what kind plus his Gtube placement. Just as I chart when it's completed and flushed.
My agency knows we work as paras and says we are not to but won't say anything

k1p1ssk, BSN, RN · Oct 18

For context, I am a building-based school nurse. I would almost recommend cross-posting this in the School Nursing sub-forum.... We are quite active and you may get more responses there.

My first big question: You are an agency nurse. Is the school contract with the agency, or is the contract still with the family? Or is it both, meaning an agency nurse provides care in-school and at home? You said you've been with this student for 4 years... I'm guessing the family is who initially contracted, but if it's now the school, then read on.

If it is still the FAMILY, then you likely do not have to provide in-school para services, unless that is part of your agency contract. The decision to have a 1:1 nurse/para in a school is going to be pursuant to an IEP or 504 plan, due to his disability. Typically, it would be the responsibility of the school to provide this.

As a result, your situation is common and expected, especially if the SCHOOL contracted with the agency. When the student is receiving medical care, then it is expected that they are not doing academics at that time and vice versa, therefore two people providing services for the student is redundant, as one would be idle while the other is providing care/academics. Should it be this way? No. But we all know that schools are underfunded and pennies will be pinched wherever they can be.

I have no idea what is required of you regarding charting, but in my experience working 1:1 in a school, most charting would be flow-sheets, as the commenter above mentioned (check boxes, etc.), especially if the student is at baseline. Maybe a narrative note at the end. If you are required to do more, is it all on paper? Can you do anything differently to be more efficient? You say you are disciplined for clocking out late, but are you being disciplined for the quality of your charting? I would talk to your supervisor about this piece specifically.

As a side note, I don't know what kind of relationship you have with the parents, but one thing they can do is try to get this child's 504 or IEP amended to include the need for a 1:1 nurse AND a 1:1 para. It isn't likely to be supported by the school/district, but it is something to consider.

jbassLPN, LPN · Oct 24

It sounds like the teacher is acting like they are your boss. Sometimes it can feel like being mean, but tell them that you were not hired as a para and you are no longer able to take on those responsibilities as it is cutting into your ability to properly care and document for your patient. Your number 1 job and concern is to take care of the child you are assigned to. Being short staffed is their problem, not yours. You could also tell the teacher or admin that they can talk to your agency if they have any questions or concerns. The squeaky wheel gets the grease! Be the squeaky wheel and keep advocating for yourself.